CASE 534: TUMOR INTRA PSOAS MUSCLE, Dr PHAN THANH HAI, Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 60YO WITH LUMBAGO ON LEFT SITE.
ULTRASOUND DETECTED HYPOECHOIC MASS INTRA LEFT PSOAS MUSCLE, SIZE 4 CM   LOOKED LIKE ABSCESS   BUT BLOOD TEST IS NORMAL  ( US1, US 2 , US3).

MRI  OF ABDOMEN DETECTED  ONE MASS  WELL BORDERED,  SIZE 4-3CM  INTRA PSOAS MUSCLE NEAR  LEFT LATERAL BORDER OF  LUMBAR SPINE L1  ( MRI 1). 

MRI 2 : SAGITAL VIEW ,  MRI 3 :  T2 W.    

RADIOLOGIST  SUSGESTED  A NEURO TUMOR   

CORE BIOPSY UNDER ULTRASOUND GUIDING IS  NEURINOMA.

OPERATION  REMOVED THIS TUMOR.

CASE 533: RETROPERITONEAL HEMATOMA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 60YO WITH ACUTE  EPIGATRIC PAIN.

ULTRASOUND EMERGENCY  OF ABDOMEN DETECTED  =
U S 1 :  RIGHT KIDNEY HYDRONEPHROSIS IN FIRST DEGREE).

U S 2 : ONE  9CM MASS   AT BIFURCATION OF ABDOMINAL AORTA TO PELVIS,  HYPOECHOIC STRUCTURE  WITH DEPLACEMENT OF R/L ILIAC ARTERIES).

U S 3: THIS MASS  AT LEFT ILIAC ARTERY.

U S 4 : THIS MASS AT RIGHT ILIAC ARTERY. IT COULD BE A HEMATOMA IN RETROPERITONEUM.
  

EMERGENCY CT CE OF ABDOMEN=

C T 1 : CROSSED SECTION AT R/L KID  SHOWS HYPOPERFUSION IN RIGHT KIDNEY.

C T 2 : CROSSED SECTION AT PELVIS MASS  RUPTURE OF ILIAC ANEURYSM.

C T 3:  FRONTAL VIEW.

C T 4: SAGITTAL VIEW OF  THIS MASS.

C T 5: 3D  VASCULAR  RECONSTRUCTION WITH 2 MASSES LEAKING OF CONTRAST AT R/L ILIAC ARTERIES.

EMERGENCY ENDOVASCULAR  STENTING  OF R/L COMMUN ILIAC ARTERIES WAS DONE SUCCESSFULLY.

SUMMARY:  HEMATOMA IN RETROPERITONEUM DUE TO RUPTURES OF R/L COMMUN ILIAC ARTERIES ANEURYSMS  DETECTED BY ULTRASOUND AND CT WITH CE.

CASE 532: URINOMA and A 2-Year Tap Wound, Dr PHAN THANH HAI, Dr NGUYEN THE ANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 26 YO WITH ABDOMEN PAIN AND DISTENTION.
 US of ABDOMEN DETECTED ASCITES AND LEFT KIDNEY HYDRONEPHROSIS, RIGHT LUNG WITH FLUID COLLECTION ( US 1  R LUNG,  US 2 L KID,  US 3 PELVIS FRONT, US 4 SAGITTAL PELVIS).

X-RAYS OF ABDOMEN DETECTED  METALIC OBJECT AT PELVIC LIKE KNIFE.

MSCT OF THORAX AND ABDOMEN = CT1  CROSSED-SECTION THE  LUNG, CT2  FRONTAL VIEW  LUNG -ABDOMEN,  LEFT KIDNEY HYDRONEPHROSIS, CT  3D VIEW OF  ABDOMEN.

OPERATION   REMOVED A KNIFE HAVING TAP WOUND 2 YEARS BEFORE AT THE LEFT FLANK LOCATED AT CUL- DE- SAC.

 ASCITES ANALYSIS  IS URINE   AND LEFT URETER  HAD BEEN RUPTURED  AND LEAKING URINE TO RETROPERITONEUM AND INTRA ABDOMEN

CONCLUSION:   URINOMA FORMATION BY TAP WOUND AT LEFT FLANK.

CASE 531: TOOTHPICK PERFORATING SPLEEN, Dr PHAN THANH HAI, Dr LE VAN TAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 46 yo  with epigastric pain,  gastroscopic result is  gastritis but being treated with  no response. 

Ultrasound of abdomen   detected  foreign body ( fb) intra the spleen that looked like the toothpick

US 1  the  fb is long 5 cm  intra central hilus the pleen to peripheral,  (US 1  crossed-section).

US  2 with CDI vascular of spleen.

US 3 :  hilus the spleen.

US 4 video.

Blood test is normal.  Colonoscopy is normal.

MSCT of abdomen  confirmed the  toothpick in penetration of the spleen, from the gastric wall to hilus of pleen.

Operation  removed toothpick in hilus of spleen,

as views by via ultrasound and CT.

CASE 530: UMBILICOURACHAL SINUS ABSCESS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 36YO, WITH HISTORY OF  SWOLLEN UMBILUS  AND DISCHARGE  AS A  PUS MASS FOR ONE MONTH.

ULTRASOUND SCANNING  SHOWS THE UMBILUS AREA  HAVING ONE MASS # 4 CM   INTRA ABDOMEN WALL AND AIR CONTENT ( US 1).

  

US 2 :CDI  SHOWS   TWINKLING  ARTIFACT  DOPPLER  CONNECTED TO URINARY BLADDER.

CT WITH CE : THIS MASS WITH ROUND BORDER  INTRA ABDOMEN WALL CONNECTED TO UMBILICUS (CT1, CT2  CROSSED-SECTION AND SAGITAL SECTION).

BLOOD TESTS = WBC RISES 12K,  CRP 12ng/mL,

RADIOLOGIST DIAGNOSTIC IS AN ABSCESS OF URACHAL SINUS.

OPERATION REMOVED THE ABSCESS.

CASE 529: CC HCC, Dr PHAN THANH HAI, Dr DUONG NGOC THANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 66 YO,   ULTRASOUND CHECK -UP DETECTED ONE MASS  5 CM AT R LIVER   HYPERECHOIC WELL- BORDERED  LOOKS LIKE  HEMANGIOMA (US 1, US 2, CENTRAL TUMOR NECROSIS).

BLOOD TESTS=  HBV AND HCV NON REACTIVE   WAKO TEST  STRONG POSITIVE.

MRI OF LIVER WITH GADOVIST , THIS TUMOR IS ENHANCED WITH GADO AND  STRUCTURE IS MORE FATTY TISSUE .  RADIOLOGIST REPORT IS AML LIVER ( MRI 1, MRI 2, MRI 3).

 CORE BIOPSY REPORT IS MORE FATTY TISSUE  WITH THE  SAME NUMBERS OF ABNORMAL CELL.

OPEN SURGERY RESECTION OF TUMOR  ( SEE MACRO  TUMOR WHICH IS  VERY DIFFERENT WITH LIVER TISSUE , WHITE  HARD   CENTRAL NECROSIS  WELL-BORDERD. MACRO 1, MACRO 2).

MICROSCOPIC REPORT IS  CLEAR CELL HCC   MORE 50%  CLEAR CELLS IN TUMOR.

CASE 528: LIVER TUMOR, Dr PHAN THANH HAI, Dr JASMINE THANH XUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 69 yo with history of mastectomy due to breast cancer for 18 years. Now for a screening  she chose full body CT.

CT reported a liver mass   at segment 5 ,  size# 6cm  (CT 1 and  CT 2).

Ultrasound reviewed:

 US 1: Liver  picture scan in April 2018  is  normal

US 2 :   A hypoechoic mass near the gall bladder.

US 3: Vascular supply for this mass is central tumor.

Blood tests= Wako test normal,  CA 15-3  normal .

MRI of liver with primovist  made  diagnostic  by radiologist is metastasis to liver ( MRI 1,  2,  3, 4).

Ultrasound guided  core biopsy  report = fibrosis

Summary of this case:
 A  mass in liver # 6 cm  suspected metastasis from breast cancer had been
 treated 18 years before and waiting for operation.
Operation of robotic laparoscopy removed big tumor and gall bladder.

Microscopic report is metastasis from suspected breast cancer.

MICROSCOPIC REPORT WITH IMMUNO-HISTOCHEMISTRY IS  METASTASIS MAY BE FROM BREAST CANCER  BEINGTREATED 18 YEARS AGO.

Reference   TNM  AND M DELAYED.